• Bergman GJ
• Winters JC
• Groenier KA
• Meyboom-De Jong B
• Postema K
• van der Heijden GJ

• Factor Analysis, Statistical
• Manipulation, Spinal
• Mobilization
• Neck Pain / therapy
• Physical Examination
• Shoulder / physiopathology
• Shoulder Pain / therapy

Methods: This was a randomized controlled trial in a primary care setting in the Netherlands. A total of 150 participants were recruited from December 2000 until December 2002. All patients received usual care by the general practitioner. Usual care included one or more of the following depending on the needs of the patient: information/advice, oral analgesics or nonsteroidal antiinflammatory drugs, corticosteroid injections, exercises, and massage. In addition to usual care, the intervention group received manipulative therapy, up to 6 treatment sessions in a 12-week period. Twenty-four physical examination tests were done at baseline and after 6, 12, and 26 weeks. Factor analysis was done to reduce the number of outcome measures.

Results: The factor analysis resulted in 4 factors: “shoulder pain,” “neck pain,” “shoulder mobility,” and “neck mobility.” At 6 weeks, no significant differences between groups were found. At 12 weeks, the mean changes of all 4 factors favored the intervention group; the factors “shoulder pain” and “neck pain” reached statistical significance (95% confidence interval [CI], 0.1-2.1). At 26 weeks, differences in the factors “shoulder pain” (95% CI, 0.0-2.6), “shoulder mobility” (95% CI, 0.2-1.7), and “mobility neck” (95% CI, 0.2-1.3) statistically favored the intervention group.

Conclusion: In this pragmatic study, manipulative therapy, in addition to usual care by the general practitioner, diminished severity of shoulder pain and neck pain and improved shoulder and neck mobility.

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